The Royal Zoological Society of Scotland's Approach to Assessing and Promoting Animal Welfare in Collaboration with Universities.

Good zoos have four aims-to conserve species, educate the public, engage in research, and provide recreation-all of which can only be achieved when underpinned by high animal welfare standards. In this paper, we share the approach that The Royal Zoological Society of Scotland's (RZSS) Edinburgh Zoo and Highland Wildlife Park take to animal welfare. We highlight the role that animal welfare research, in collaboration with universities, has had in enabling the zoo to take an evidence-based approach to welfare and to put findings into practice.

Documentation of International Classification of Headache Disorders Criteria in Patient Medical Records: A Retrospective Cohort Analysis.

Objective: To determine headache diagnosis and treatment patterns in the outpatient setting, focusing on documentation of the International Classification of Headache Disorders (ICHD) criteria.

Design, Setting, And Participants: Retrospective cohort data were collected from electronic medical records of adults aged 18-35 who presented to resident-staffed family medicine outpatient clinics in the Midwest, USA, for a new or worsening headache between 2015 and 2016. Diagnosis codes were used to summarize the overall nature and prevalence of headaches.

Plastic Surgery Tourism: Complications, Costs, and Unnecessary Spending?

Background: The liability of plastic surgery tourism in patient health and postoperative resource allocation is significant. Procedures completed within the context of medical tourism often lack rigorous quality assurance and provide limited preoperative evaluation or postoperative care. Not only does this jeopardize the patient's well-being, but it also increases the financial burden and redirects invaluable resources domestically through often unnecessary diagnostic tests and hospitalizations.

Factors Associated With No-Show to Ambulatory Tele-Video Neurology Visits.

Introduction Telehealth visits (TH) have become an important pillar of healthcare delivery during the COVID pandemic. No-shows (NS) may result in delays in clinical care and in lost revenue. Understanding the factors associated with NS may help providers take measures to decrease the frequency and impact of NS in their clinics.

Driving Impairment and Healthcare Provider Counseling in Rheumatoid Arthritis and Osteoarthritis Patients: A Cross-Sectional Survey.

Background/objective: To examine rates of counseling on driving for individuals with osteoarthritis (OA) and/or rheumatoid arthritis (RA) and evaluate the Health Assessment Questionnaire Disability Index (HAQ-DI) as a screening tool for further driving evaluation.

Methods: A cross-sectional survey was completed by individuals recruited via ResearchMatch (a national web-based recruitment tool) between March 5 and April 20, 2020. Individuals with a current US driver's license, ≥18 years old, with self-reported OA and/or RA diagnosis were surveyed about driving difficulty and vehicle modification and completed a HAQ-DI assessment.

Airway Obstacle Course for Teaching Prehospital Providers Airway Techniques.

Background:  Early airway intervention is a vital step in the management of critically ill patients. Emergency medical service (EMS) providers are often first in the chain of survival with equipment to manage airway problems that arise. Therefore, it is paramount that they receive thorough training in aspects of airway management.

Simulation Improves Internal Medicine Resident Confidence With Defibrillation, Cardioversion, and Transcutaneous Pacemaker Use.

Introduction While many graduate medical education programs require residents to be certified in advanced cardiac life support, this does not cover all aspects of cardiac stabilization in patients with a pulse. Residents are often on the front lines of providing care to patients with life-threatening dysrhythmias. Our residents expressed a lack of confidence in their ability to provide this care.

Cervical cancer radiation therapy compliance rates based on location of radiation therapy.

Objective: Completion of radiation therapy (RT) within 60 days has been proposed as a national quality measure for patients with carcinoma of the cervix as protracted RT has been associated with worse oncologic outcomes. The objective of this study was to compare compliance rates based on location of RT administration.

Methods: This was a retrospective chart review of patients diagnosed with cervical cancer between January of 2000 to December of 2016 who were planned to undergo primary treatment with sensitizing chemotherapy and RT.

The effect of art therapy on the quality of life in patients with a gynecologic cancer receiving chemotherapy.

Objectives: Most art therapy research has involved patients with malignancies other than gynecologic cancer. The current study aimed to assess the impact of an art therapy intervention on the quality of life (QOL) in patients with gynecologic cancer who were receiving chemotherapy.

Methods: This was a prospective, non-randomized, pilot study.

Multidisciplinary Approach to Improve Sepsis Outcomes.

Severe sepsis and septic shock cause significant morbidity and mortality with health care costs approximating $17 billion annually. The Surviving Sepsis Campaign 2012 recommended time-sensitive care bundles to improve outcomes for patients with sepsis. At our community teaching hospital, a review of sepsis management for patients admitted to a medical intensive care unit (ICU) between December 2015 and March 2016 found 70.

The Effect of an Educational Pamphlet on Patient Knowledge of and Intention to Discuss Screening for Obstructive Sleep Apnea in the Acute Ischemic Stroke Population.

Background: The relationship between obstructive sleep apnea (OSA) and stroke is well established, thus supporting the importance of secondary prevention via screening and treatment for acute ischemic stroke survivors. Educational pamphlets are commonly used for patient education; however, none currently available on OSA have evaluated. The aim of this study was to evaluate the effect of a brief educational intervention on patient knowledge and interest in OSA screening.

Impact of a telemedicine eICU cart on sepsis management in a community hospital emergency department.

Introduction Intensivist involvement for patients with sepsis is associated with decreased complications and mortality, and lower hospital resource utilization, but few studies have evaluated outcomes for patients exposed to electronic intensive care unit (eICU) telemedicine sepsis management in the emergency department (ED). In this study, we assess whether eICU cart exposure in the ED improved compliance with components of the 2010 Surviving Sepsis Campaign bundles, length of stay (LOS), disposition and hospital costs. Methods An institutional review board-approved, retrospective cohort study was completed on patients with confirmed sepsis who presented to our ED from July 2010 through February 2013.

Oral Ketorolac for Pain Relief During Intrauterine Device Insertion: A Double-Blinded Randomized Controlled Trial.

Objective: To evaluate if oral ketorolac provides effective pain relief during placement of an IUD for contraception.

Methods: We conducted a double-blinded randomized controlled trial in a community hospital in Columbus, Ohio. Participants that met eligibility criteria were consented and randomized to receive either oral ketorolac 20 mg or placebo 40 to 60 minutes before IUD placement.

Hospitalist Versus Subspecialist Perspectives on Reasons, Timing, and Impact of Consultation.

Background: Hospitalists frequently consult medical subspecialists in the management of inpatients. Given the potential impact on health resource utilization, it is important to understand the working relationship between these groups.

Methods: A cross-sectional survey of hospitalists, n = 655, and subspecialists across Ohio (nephrologists and endocrinologists), n = 293, was conducted to investigate perceptions and communication about reasons, timing, and impact of hospital consultations.

Twenty-Four-Hour Voiding Diaries Versus 3-Day Voiding Diaries: A Clinical Comparison.

Objective: This study aimed to determine if 24-hour versus 3-day voiding diary affects medical decision making for women with urinary incontinence.

Methods: A retrospective chart review was conducted of patients presenting to the OhioHealth Urogynecology Physician group for urinary incontinence from 2009 to 2011. Practice protocol includes patient completion of a 3-day voiding diary before their appointment.

Patient characteristics, outcomes and costs following interhospital transfer to a tertiary facility for appendectomy versus patients who present directly.

Background: Recent healthcare policy changes have emphasized pay-for-performance. Previous studies have not examined outcome differences between primary presenting appendicitis patients and transferred patients.

Methods: A retrospective cohort design examined appendicitis patients between March 2011 and 2013.

Effect of Maternal Retroplacental Leiomyomas on Fetal Growth.

Objective: To evaluate the association between retroplacental leiomyoma identified on second trimester ultrasound and fetal growth.

Methods: We performed a retrospective study comparing the presence or absence of one or more retroplacental leiomyomas on birth weight in a cohort of women with singleton pregnancies undergoing second trimester fetal anatomic ultrasound at our institution between 2007 and 2012. The incidence of small for gestational age (SGA) infants was recorded.

Improved Resident Adherence to AAA Screening Guidelines via an Electronic Reminder.

The 2014 United States Preventive Services Task Force systematic review found abdominal aortic aneurysm (AAA) screening decreased related mortality by close to half. Despite the simplicity of screening, research suggests poor adherence to the recommended AAA screening guidelines. Using the quality improvement plan-study-do-act cycle, we retrospectively established poor adherence to AAA screening and poor documentation of smoking history in our resident clinic.

A pilot study examining experiential learning vs didactic education of abdominal compartment syndrome.

Background: Current surgical education relies on simulated educational experiences or didactic sessions to teach low-frequency clinical events such as abdominal compartment syndrome (ACS). The purpose of this pilot study was to evaluate if simulation would improve performance and knowledge retention of ACS better than a didactic lecture.

Methods: Nineteen general surgery residents were block randomized by postgraduate year level to a didactic or a simulation session.

Associations with resident physicians' early adoption of electronic cigarettes for smoking cessation.

Background: Use of the electronic cigarette for nicotine delivery has increased dramatically in recent years. Information continues to emerge on its role as a smoking cessation aid, but little is known about resident physician use of the device in clinical practice.

Methods: In 2015, an electronic survey was administered to resident physicians in one healthcare system in Columbus, Ohio.

Adhesion Assessment at First Repeat Caesarean Section With or Without Prior Adhesion Barrier Use.

Objective: To determine if placing a carboxymethylcellulose adhesion barrier material at the time of primary Caesarean section (CS) leads to a reduction in adhesive disease, clinical outcomes, and hospital costs encountered at the time of a first repeat CS.

Methods: We performed a prospective cohort study of women at a large community hospital undergoing a first repeat CS with available prior operative records. A rating scale assessing the location and severity of adhesions (range 0 = no adhesions to 3 = dense and/or vascular adhesions requiring electrocautery) at the time of repeat CS was utilized by obstetric residents blinded to previous adhesion barrier use.

Bupivacaine Versus Liposomal Bupivacaine for Postoperative Pain Control after Augmentation Mammaplasty: A Prospective, Randomized, Double-Blind Trial.

Background: The long-acting preparation of bupivacaine, liposomal bupivacaine (EXPAREL, Pacira Pharmaceuticals, Inc., San Diego, CA), was approved by the Food and Drug Administration in October 2011 and has been shown to be safe in breast augmentation. It remains to be established if liposomal bupivacaine provides superior pain control in this setting.

Associations with resuscitation choice: Do not resuscitate, full code or undecided.

Objective: To examine associations of individual exposure and knowledge of resuscitation mechanics and prognosis with specific decision: Do Not Resuscitate (DNR), Full Code (FC) or Undecided (UD).

Methods: Cross-sectional questionnaire at 3 sites: geriatric assessment center, internal medicine resident clinic, and inpatient palliative care service.

Results: 407 completed the questionnaire: 27% identified as DNR, 24% as FC and 49% as UD.